SKIN DETOX: Go Gluten-Free...the Right Way

In 10 years you'll think about gluten the way you think about cigarettes. 

Gluten is a protein found naturally in many foods. It is also mixed into processed foods. While gluten intolerance is commonly associated with Celiac disease, many people do not realize that sensitivity to gluten is common among many people without Celiac disease, and has been linked to many other health complications. Gluten intolerance is a growing epidemic.

The human body has a difficult time breaking down gluten; however, attributing symptoms to gluten intake can be difficult for people because it has become a staple in the American diet. Recurring stomach pain, rashes, or fatigue should not be ignored; heart disease, Alzheimers, inflammatory bowel disease, and autoimmune diseases are only some of the health problems which gluten intake can cause. Eliminating gluten from the diet entirely is the only way to prevent its complications.

Gluten intolerance is often associated with stomach discomfort and digestive problems, however, it can also cause other symptoms without causing severe stomach upset. Other symptoms have frequently been linked to the following skin conditions:  

- Red skin rashes on the face that burn or itch

- Acne

- Red skin blemishes resembling acne

If you suspect that you are sensitive to gluten, eliminate it from you diet completely for at least two months to see if symptoms improve. Consult with your primary care physician or dietician prior to starting your new diet to ensure that you will be still be able to consume essential vitamins and minerals.

Understanding which foods have gluten is CRUCIAL to avoiding it entirely. Some food labels mention that gluten is included while others do not; gluten is often “hidden” within other ingredients listed on nutrition labels, so be sure they are truly gluten free before eating them!

Foods that are allowed:
Vegetables
Most dairy products
Unprocessed legumes (beans, nuts, seeds)
Fresh meats
Fresh fish
Fresh poultry
Rice
Buckwheat
Corn and cornmeal
Rice flour
Soy flour
Corn flour
Potato flour
Bean flour
Quinoa
Soy
Tapioca
Flax
Teff
Amaranth
Arrowroot
Sorghum
Pure apple cider vinegar
Pure balsamic vinegar
 

Foods to avoid:
Wheat
Barley
Oats
Rye
Spelt
Kamut
Pizza
Pasta
Breads and rolls
Processed lunch meats
Seasoned rice mixes
Salad dressings
Potato chips
Tortilla chips
Wraps
Malt, malt flavoring, malt vinegar
Triticale
Bulgar
Durum flour
Farina
Graham flour
Beer
Cakes & pies
Candy
Cereals
Cookies
Crackers
Croutons
French fries
Gravies
Imitation meat or seafood
Matzo
Soup

Vitamin D

Vitamin D is an important factor in the integrity of the skin and some inflammatory diseases can be caused by vitamin D deficiency. Some of these diseases include psoriasis, Crohn’s Disease, arthritis, multiple sclerosis, and systemic lupus erythematosus.

How do you get it?

Vitamin D is most commonly absorbed by exposure to the sun. It can also be absorbed from certain foods and through supplements. You may have a vitamin D deficiency if you do not spend much time out in the sun, such as in the winter, or if you have a skin condition or history of skin cancer that restricts the amount of sun exposure you can have. Dark skinned people are also prone to having low levels of vitamin D from sun exposure. Vitamin D deficiency may also be due to low intake of foods rich in vitamin D.

How do you get vitamin D without exposing yourself to the sun?

Eat a diet high in these foods which contain a high amount of vitamin D:
tuna
mackerel
swordfish
herring
sardines
oysters
caviar
mushrooms
egg yolks
cheese
beef liver
fortified milk
fortified cereals
fortified orange juice
fortified yogurt

Vitamin D Supplements

Supplements are a great way to boost your levels of vitamin D. There are two forms of vitamin D available in supplements - vitamin D2 or vitamin D3. Vitamin D3 has been proven to increase levels of vitamin D better than vitamin D2 does. It is recommended that you take at least 600 to 800 IU of vitamin D3 per day. If you have extremely low levels of vitamin D or trouble absorbing it, then you may need to take a higher dose. You should contact your physician to assess how much per day you should take.

Introducing: Farmhouse Fresh!

McLean Dermatology is proud to announce that we now carry Farmhouse Fresh products in our office.

Each Farmhouse Fresh product is made with 90-99% natural and naturally-derived ingredients. Everything they make is Paraben and Sulfate FREE. Man

y of their products are also Vegan and Gluten FREE.

Not to mention, they smell so good you could almost eat them!

To learn more about these awesome products visit their website and stop by the office to pick up yours today!

Before You Get Your Next Mani Pedi...

Manicure and pedicure safety is extremely important if you get your nails professionally done on a weekly basis. Here are a few Dermatologist-recommend tips before you make your next trip to the salon:

1. Apply a cream to moisturize your nails, especially after removing nail polish since most removers contain chemicals that dry the nails.
2. To prevent infection, never cut or forcefully push back your cuticles. If you must push them back, only do so gently after a shower or bath.
3. While most nail salons follow strict cleanliness and disinfection guidelines, look for the following when visiting a salon:

1. Does your nail technician have the necessary experience and/or license, if required?
2. Are the stations clean?
3. Does the nail technician wash her hands between clients?
4. Are there dirty tools lying around?
5. In addition, do not hesitate to ask how they clean their tools.

4. Shave your lower legs after getting a pedicure, not before. That means not shaving your lower legs for at least 24 hours before you get a pedicure. If you nick yourself while shaving, a pedicure could put you at risk for an infection.
5. If you get frequent manicures and pedicures, consider purchasing your own tools to be used at the salon.
6. In addition, check that the pedicure footbaths and filters are thoroughly disinfected before you use them. If they are improperly cleaned, they can harbor bacteria and fungus. If the salon does not appear clean, then move on.
7. If you want to wear a bright red or orange polish, prevent discoloration by applying an extra layer of base coat. If your nails become yellowed and discolored from the polish, your nails should return to normal color over several weeks if the same color is not reapplied.
8. While some people beg to differ, there is no scientific evidence that immersing nails in gelatin makes them stronger. Polishes that contain strengthening ingredients increase nail stiffness, which may make nails break more frequently.
9. Do not wear artificial nails to cover up nail problems as they may make them worse. Artificial nails are not recommended for people who are prone to fungal infections or have brittle nails. For people with healthy nails, artificial nails can be fine as long as they are not worn continuously.

1. Know what products are used in your artificial nails as the substances used can cause an allergic reaction in some people. If you develop a rash or other reaction, tell your doctor what products you used.

If you have any nail care questions, be sure to call and schedule an appointment with Dr. Talakoub. 

http://www.aad.org/skin-conditions/skin-health-tips/manicure-and-pedicure-safety/manicure-and-pedicure-safety#.UWmoqu2zK-I

Spring = Skin Check Season

Before the summer sun cooks your skin and you start to look like your leather handbag, come in for a comprehensive head-to-toe skin check and cancer screening.

At McLean Dermatology, we are committed to providing you with the best dermatologic care – that includes ensuring you and your skin are ready for this, and every, summer.

The rate of melanoma, which is the deadliest form of skin cancer, has increased in the U.S. at a rapid pace. Why, do you ask? Everybody knows you must live by the rule: apply and reapply!  Proper sun protection - sunscreen, hats, sunglasses, rash guards, and surf shorts – are all must-haves in the sun.

There are so many choices of sunscreens, which one do I buy?

-Look on the bottles for these words: water-resistant, broad-spectrum, SPF 30 or higher (Ex: Elta MD)

Do I still have to wear sunscreen even when it’s cloudy?

-Yes! The most harmful, UV rays, can pass through windows, clouds, rain, and cement.

If I wear foundation with SPF, is that enough?

-Although it helps, wearing just makeup with a built-in SPF is not strong enough. Make it a habit to put on sunscreen before your makeup.

Outsmart skin cancer with these helpful hints:

Avoid tanning beds

   -Even one tanning session increases your lifetime risk of developing melanoma by 20%!

Apply your SPF in the morning (and REAPPLY!)

   -If you’re out all day and not reapplying sunscreen every 40-80 minutes you’re putting yourself at risk.

Eat your fruits and veggies

   - Leafy greens and citrus fruits guard against UV damage

Perform self-tests

   - Any mole or spot you think might be harmful very well could be. Making an appointment with your dermatologist is the first step to healthy skin.

Do not smoke

   -Up there with tanning beds, smoking in a Class 1 carcinogen.

Is Your Bowel Linked to Your Skin?

Ever wonder if your skin rash or pimples could be related to your diet? More specifically could the gluten in your diet be triggering your symptoms?  Everyday more and more benefits of gluten-free diets are being discovered.   

Gluten-free diets are most commonly used to manage celiac disease, which causes the immune system to trigger a reaction in the gut to gluten, a protein which is found in wheat, barley, rye, malts and triticale.  But what if you have never been diagnosed with celiac disease?  In a recent study published in Journal Watch General Medicine, patients without celiac disease but symptoms of celiac sensitivity, experienced relief from their symptoms after adopting a wheat-free diet.  

Therefore, whether you have celiac disease, a gluten sensitivity, or neither, experimenting with a gluten-free diet has several potential benefits. Patients in our clinic with eczema, acne, and peri-oral dermatitis have seen benefits with glow gluten or gluten free diets! Luckily, with the growing popularity, many grocery stores have now made these products more accessible to consumers by adding gluten-free aisles. 

As with any diet change, it is important that you maintain a balanced diet, especially when you are excluding foods you are used to eating. It is also important to continue eating a balance of proteins, carbs, healthy fats, and other nutrients. 

If you have itchy skin, acne, or rashes that do not improve with standard regimens, call Dr. Lily to discuss your diet.   

Spring Cleaning Edition: Is Your Medicine Cabinet Up to Code?

The name “medicine cabinet” is unfit for what should be held in this very important space of your home. Believe it or not, medicines are not the best items to keep here. Not only is it open to anyone including kids and snooping houseguests, the medicines that are here may be altered by the temperature and moisture. Many topical creams and ointments need to be kept in a cool dark area. Oral medications also require non-humid, cool environments, where as some even need refrigeration.

This area is also a place for medicines to sit and spoil. We often forget about how fast medications expire. Skin creams with retinol, hydroquinone, and acne medications often not only become ineffective, they can cause rashes or skin irritation if expired. The best rule of thumb is ‘when in doubt, throw it out.’ Just be sure you are disposing the medicine in an FDA approved manner. See www.fda.gov, ‘How to Dispose of Unused Medicines.’

Even if you don’t keep medicines in your medicine cabinet you should always keep it clean! Most people simply wipe the mirror in the front of the cabinet! Do yourself a favor tonight (in light of spring) and give your medicine cabinet a deep clean.

1) Remove everything

2) Throw out the old medicines and cosmetics, check expirations

3) Wipe clean

1)  Organize your favorite products and replace anything you had to purge!

2)  Keep topical antibiotics, skin creams, sunscreen, all within a tight cap and in a locked drawer or linen closet.

Good timeline for products:

-       3-5 years: Eye and lip pencils, hair styling products

-       2-3 years: shampoo, conditioner, shower gel, body lotion, perfume, foundation, lipstick, lip-gloss

-       2 years: Bar soap, shaving cream, deodorant

-       1 year: Nail polish, bath oil

-       3-4 months: Mascara and liquid eyeliner

*Anti-aging, acne treatment, and sunscreen shelf life depends on expiration dates on the bottle.

Take the first steps to your Spring-cleaning efforts and give your medicine cabinet a check-up!

Seven Daily Habits that are Aging Your Skin

The quest for ageless skin can be tedious and quite frankly, expensive.  Here are seven everyday (bad) habits to avoid doing to achieve the look of younger skin.

1.    Not Wearing SPF – Even though your tan looks great now, your skin will be covered in wrinkles years down the road. Wearing the proper sun protection not only protects against the formation of wrinkles, but also helps keep skin moisturized all year round. Dr. Lily recommends a daily SPF 45 or greater with UVA/UVB protection such as Elta MD. Harmful UV rays are not just present in the sunny summer months, but in the winter months too!

2.    Smoking – There are no benefits to smoking. Every time you smoke a cigarette you are breathing in carcinogens and toxins that are damaging the largest organ in your body: your skin… not to mention the wrinkles around your mouth caused by the repetitive motion of puckering your lips.

3.    Eating Sweets – A diet high in sugar leads to poor nutrition for your skin. Research shows that sugar attaches to the proteins that work to damage other proteins like collagen and elastin.  Once attacked, the ability to keep your skin firm is reduced and brittle, leaving dull, cracked skin.

4.    Not Wearing Sunglasses – You should be wearing eye protection everyday. Shading your eyes from the sunlight will prevent squinting, preventing future wrinkles in your forehead area and the area around your eyes. Unprotected sun exposure to the eyes can cause eye cancer, cataracts, and even blindness.

5.    Chewing Gum – A habit among many to cover up bad breath, chewing gum is linked to the formation of wrinkles around your mouth.  The repetitious up and down motion causes wear and tear on your skin resulting in wrinkles.

6.    Sleeping Position – We all have preferable sleeping positions that feel most comfortable to us.  Whether you’re a stomach, back, or side sleeper the position in which you sleep can expose you to sleep lines that ultimately become etched in your face. Side sleepers are more susceptible to chin, cheek, and chest lines, whereas stomach sleeps are more prone to forehead wrinkles.

7.    Stress – It’s true! Stress ages you! It weakens your immune system making you more vulnerable to oxidative damage to the skin. 

Food Industry Marketing

Did you know that every year the average american eats:

• Thirty three pounds of cheese, triple that amount that was consumed in 1979
• Seventy pounds of sugar, about twenty two teaspoons a day
• 8,500 milligrams of salt a day, double the recommended amount

With these facts it is clear why twenty-six million Americans have diabetes and one-in three adults and one-in-five kids is clinically obese.  

Meanwhile, instead of altering products to make them healthier the food industry is instead constantly changing marketing campaigns and ingredients to keep up with the next fad.  By decreasing one ingredient but at the same time pumping up another ingredient, companies are still able to sell themselves as “fat-free or low-salt”.  It is a common technique used to deceive the consumer in thinking they are consuming a healthier product while in reality it may have been altered in a way that actually makes it worse for you.

When grocery shopping it is best to avoid all the low salt, low fat, low sugar fads, they are all just a manipulation of ingredients for marketing purposes.  A diet high in protein and vegetables and low in processed food is still historically the best diet for your health.  Consumers need to be aware that 90% of labels are JUST marketing.  

The Puzzling Relationship Between Diet and Acne

The relationship between acne and diet has been an ongoing debate. There are no meta-analyses, randomized controlled clinical studies, or well-designed scientific trials that follow evidence-based guidelines to elucidate a cause-effect relationship. However, for decades anecdotal evidence has shown that acne and insulin resistance, such as that seen in patients with polycystic ovarian syndrome (PCOS), are highly linked. Now the literature points to the growing relationship between nutrition and the prevalence of acne, especially to glycemic index and the consumption of dairy.

Glycemic index is a ranking system based on the quality and quantity of consumed carbohydrates and its ability to raise blood sugar levels. Foods with high glycemic indices such as potatoes, bread, chips, and pasta, require more insulin to maintain blood glucose levels within the normal range. High-glycemic diets that are prevalent in the United States not only lead to insulin resistance, diabetes, obesity, and heart disease but also to acne.

Several studies have looked at the glycemic load, insulin sensitivity, and hormonal mediators correlating to acne (Am. J. Clin. Nutr. 2007; 86:107-15; J. Dermatol. Sci. 2008;50:41-52). Foods with a high-glycemic index may contribute to acne by elevating serum insulin concentrations (which can stimulate sebocyte proliferation and sebum production), suppress sex hormone-binding globulin (SHBG) concentrations, and raise androgen concentrations. On the contrary, low-glycemic-index foods increase SHBG and reduce androgen levels; this is of great importance because higher SHBG levels are associated with lower acne severity. Consumption of fat and carbohydrates increases sebum production and affects sebum composition, ultimately encouraging acne production (Br. J. Dermatol. 1967;79:119-21).

A new study by Anna Di Landro et al. published in the December 2012 found a link between acne and the consumption of milk, particularly in those drinking skim milk and more than three servings of milk per week (J. Am. Acad. Dermatol. 2012;67:1129-35).

Dr. Di Landro et al. also found that the consumption of fish had a protective effect on acne. This interesting finding points to the larger issue of acne developing in ethnic populations that immigrate to the United States. Population studies have shown that non-Western diets have a reduced incidence of acne. Western diets are deficient in long-chain omega-3 fatty acids. The ratio of omega-6 to omega-3 fatty acids in our Western diet is 10:1 to 20:1, vs. 3:1 to 2:1 in a non-Western diet. Omega-6 fatty acids in increased concentrations induce proinflammatory mediators and have been associated with the development of inflammatory acne. Western diets with high consumption of seafood have high levels of omega-3 fatty acids and have shown to decrease inflammatory mediators in the skin (Arch. Dermatol. 2003;139:941-2).

In my clinic, the ethnic populations that immigrate to the United States often develop acne to a greater extent than they had in their native countries. Although factors including stress, hormonal differences in foods, and pollution can be confounding factors, we must not ignore the Western diet that these populations adapt to is higher in refined sugars and carbohydrates and lower in vegetables and lean protein. Every acne patient in my clinic is asked to complete a nutritional questionnaire discussing the intake of fast food, carbohydrates, juice, sodas, and processed sugar. We have noticed that acne improves clinically and is more responsive to traditional acne medications when patients reduce their consumption of processed sugars and dairy and increase their intake of lean protein. Similarly, our PCOS patients who are treated with medications such as metformin, which improves the body’s ability to regulate blood glucose levels, have improvements in their acne. So, is acne a marker for early insulin resistance?

The underlying etiology of acne is multifactorial, although now we can appreciate diet as one of the causative factors. Although there is no direct correlation between obesity or insulin resistance and the prevalence of acne, a low glycemic index diet in combination with topical and systemic acne medications can be a powerful method of treating acne. Nutritional counseling is an adjunct educational service we should provide to our patients in addition to skin care advice and medical treatments for acne.

No single food directly causes acne, but a balanced diet can alter its severity. Encouraging our patients to eat a variety of fruits and vegetables, lean protein, and healthy fats can prevent the inflammation seen with acne and also can protect against cardiovascular disease, type II diabetes, and even obesity.

It is unfortunate that the medical education system in the United States has no formal nutrition education. Nearly every field of medicine including internal medicine, cardiology, endocrinology, allergy, pediatrics, obstetrics and gynecology, surgery, and not the least, dermatology, is influenced in some realm by nutrition. As the population diversifies, so will the importance of dietary guidance. We need to educate ourselves and our residents-in-training to better appreciate the symbiotic relationship between diet and skin health and to provide this guidance to our patients.

By: LILY TALAKOUB, M.D., Skin & Allergy News Digital Network